After completing his debut opera, Nixon in China (1985-87)—the most exhaustive of Adams's compositions up to that point, and his first foray into writing for solo voice—aspects of the Nixon music continued to echo in two utterly different pieces, both composed within the same year. The opera's exhilarating, brash energy—including the minimalist techniques that were part of its DNA—spilled over into the orchestral work Fearful Symmetries, described by Adams as "a seriously aerobic piece, a Pantagruel boogie with a thrusting, grinding beat." But with The Wound-Dresser, Adams went on to explore another key element of Nixon's language: the melancholy and meditative strain heard in Pat Nixon's aria, which also permeates much of the opera's final act (especially the concluding solo delivered by Chou En-lai).

These two post-Nixon works are actually emblems of an ongoing, fundamental polarity in the music of Adams. The composer himself has characterized this as a "psychic balancing act" between what he describes as his "Trickster" persona—"the garish, ironic wild card"—and a more introspective, "serious" attitude (the two can, of course, coexist within the same work). In terms of literary prototypes, Mark Twain's brand of wry humor comes to mind with the former category, while Walt Whitman serves as the inspiration for The Wound-Dresser, a moving example of the latter.

Adams had run across an edition of Whitman's Specimen Days that juxtaposed haunting photographs of the Civil War wounded alongside the poet's recollections of this dark period. Initially he imagined setting excerpts from Whitman's prose accounts to music, but recent experiences led him instead to select the poem "The Wound-Dresser." In 1988, the composer's father died, after several years of struggling with Alzheimer's, and Adams found himself returning to the image of his mother caring for her husband as his illness progressed. Whitman's poem appealed because of its combination of honest directness and precision, without resorting to melodrama. "Both graphic and tender," Adams writes, the poem contains "perhaps the most intimate recollection" of Whitman's experiences of the suffering of wartime. Adams was also struck by the examples he had observed of Bay Area friends nursing loved ones during those helpless early years of the AIDS epidemic. Ultimately, for him, "The Wound-Dresser" is about the power of "human compassion that is acted out on a daily basis."

Whitman left Brooklyn in 1862 to tend to a brother wounded while fighting in the Union Army. For the remaining years of the Civil War, he decided to devote himself to bringing what comfort he could to the maimed (and often forgotten) young soldiers who thronged the impromptu tent hospitals that had sprouted up around Washington, D.C. Whitman drew on his experiences of endless hours spent with the sick and dying in "The Wound-Dresser," which he eventually published in the Civil War collection Drum-Taps. (The poem's final stanza has been engraved onto the Q St. entrance to the Dupont Circle Metro Station.)

Adams opted not to set the opening stanzas that frame the poem as the recollections of an old man. Instead, he plunges directly into the reality of the hospital scene, where the narrator is "bearing the bandages." The score plays up the tension between its shifting, hallucinatory orchestral fabric and the "naturalistic," matter-of-fact declamation of the baritone's vocal line. Adams takes great care to follow the patterns of Whitman's prosody but allows his imagery to resonate in the orchestra's counterpoint and commentary.

Solo instruments emerge into the foreground in eloquent duets with the singer: first a violin at the high end of its range; as the emotional landscape becomes more turbulent, an elegiac piccolo trumpet takes flight. The soaring trumpet, which extends the battlefield's metaphorical reach inward, represents a signature Adams sound: It appears, for example, in Pat Nixon's aria or the slow movement of Harmonielehre (titled, not coincidentally, "The Anfortas Wound"). But it's also a reference to an American signature, as in Ives's The Unanswered Question and, indeed, several Copland works (including Billy the Kid's meditative night scene).
The overall musical plan of The Wound-Dresser develops from a disturbing, almost dreamlike melancholy—it seems at first to float in slow-motion—through a series of increasingly intense climaxes, with much telling detail along the way, before the earlier strains are subtly varied to reach a gently serene, unsentimental close.